血清前列腺健康指数对tPSA灰区前列腺癌患者的诊断价值探讨  

Diagnostic Value of Serum Prostate Health Index in Prostate Cancer Patients with PSA Gray Area

作　　者：潘良明 沈菲菲 马晓英 李佳慧 王倩倩 沈建良 PAN Liang-ming;SHEN Fei-fei;MA Xiao-ying;LI Jia-hui;WANG Qian-qian;SHEN Jian-liang(Department of Urolog,Shanghai Jinshan District Tinglin Hospital,Shanghai 201505,China;Department of Rehabilitation,Shanghai Jinshan District Tinglin Hospital,Shanghai 201505,China;Department of Emergency,Shanghai Jinshan District Tinglin Hospital,Shanghai 201505,China)

机构地区：[1]上海市金山区亭林医院泌尿外科,上海201505 [2]上海市金山区亭林医院康复科,上海201505 [3]上海市金山区亭林医院急诊科,上海201505

出　　处：《现代检验医学杂志》2021年第1期72-76,99,共6页Journal of Modern Laboratory Medicine

基　　金：上海市金山区科委课题(课题编号:2016-3-25)。

摘　　要：目的探讨前列腺健康指数(PHI)在血清总前列腺特应性抗原(tPSA)灰区(4~10 ng/ml)前列腺癌(PCa)患者中的诊断价值。方法选择2018年3月~2019年10月上海市金山区亭林医院泌尿外科收治的94例血清tPSA在4~10 ng/ml的老年男性患者临床资料。其中PCa组21例,前列腺良性增生(BPH)73例。检测两组患者血清中tPSA、游离PSA(fPSA)以及前列腺特异性抗原前体2型(p2PSA)的指标水平,从而计算得出fPSA/tPSA比值和PHI,并绘制tPSA,fPSA/tPSA,p2PSA以及PHI的受试者工作特征(ROC)曲线,得出曲线下面积(AUC)、95%CI以及截断值(cut off value),分析tPSA,fPSA/tPSA,p2PSA以及PHI的检测对PCa患者的早期诊断价值。结果两组患者的血清tPSA,fPSA和p2PSA水平差异均无统计学意义(U=899,450和261.5,均P>0.05);两组患者fPSA/tPSA(U=261.5,P=0.023)与PHI(t=1275.5,P<0.001)指标的差异有统计学意义(均P<0.05)。tPSA,fPSA/tPSA,p2PSA以及PHI的ROC曲线下面积分别为0.586,0.676,0.613和0.832,其中tPSA,fPSA/tPSA和p2PSA(AUC值均<0.7)的诊断效能较低,而PHI的诊断效能较高。血清PHI的准确度(81.9%)明显高于tPSA,fPSA/tPSA和p2PSA,差异有统计学意义(χ^2=6.975,4.145和6.211,均P<0.05)。tPSA及p2PSA指标对提高PCa的诊断效率无明显助益(均P>0.05),fPSA/tPSA和PHI明显提高Pca的诊断效力(P<0.05),其中PHI的诊断效果最佳(P<0.001),PHI的AUC值0.832(95%CI:0.733~0.931)高于fPSA/tPSA的AUC值0.676(95%CI:0.539~0.812),差异有统计学意义(Z=2.758,P<0.01)。结论PHI诊断tPSA灰区PCa患者的诊断效能与准确性均较高,具有比tPSA,fPSA/tPSA和p2PSA更高的诊断价值。Objective To investigate the diagnostic value of prostate health index(PHI)in prostate cancer(PCa)patients with serum tPSA gray area(4~10 ng/ml).Methods The clinical data of 94 elderly male patients with tPSA at 4~10 ng/ml diagnosed by prostate biopsy from March 2018 to Octorber 2019 were selected.There were 21 cases of prostate cancer(PCa)and 73 cases of benign prostatic hyperplasia(BPH).The index levels of tPSA,fPSA and p2PSA were detected,and the ratio of fPSA/tPSA and PHI were calculated.The receiver operating characteristic(ROC)curves of tPSA,fPSA/tPSA,p2PSA and PHI were drawn.The area under the curve(AUC),95%CI and cut-off value were obtained.The early diagnostic values of tPSA,fPSA/tPSA,p2PSA and PHI in patients with PCa were analyzed.Results There were no significant differences in age,serum tPSA,fPSA and p2PSA levels between PCA group and BPH group(U=899,450 and 261.5,all P>0.05)and there were significant differences in fPSA/tPSA(t=2.103,P=0.041)and PHI(t=3.560,P<0.001)between the two groups(P<0.05).The area under ROC curve of tPSA,fPSA/tPSA,p2PSA and PHI were 0.586,0.676,0.613 and 0.832,respectively.Diagnostic efficacy of tPSA,fPSA/tPSA,p2PSA(AUC values<0.7)were lower than those of PHI.The accuracy of serum PHI(81.9%)was significantly higher than that of tPSA,fPSA/tPSA and p2PSA(χ^2=6.975,4.145 and 6.211,all P<0.05).tPSA and p2PSA had no significantly improvementfor the diagnostic efficacy of PCa(P>0.05),fPSA/tPSA and PHI significantly improved the diagnostic efficacy of PCa(P<0.05),and PHI had the best diagnostic efficacy(P<0.001).The AUC value of PHI 0.832(95%CI:0.733~0.931)which was higher than that of fPSA/tPSA 0.676(95%CI:0.539-0.812),and the difference was statistically significant(z=2.758,P<0.01).Conclusion PHI can be used as a tumor screening index for the diagnosis of prostate cancer patients with serum tPSA gray area.It has higher diagnostic accuracy and value than tPSA,fPSA/tPSA,p2PSA.

关 键 词：前列腺健康指数 前列腺癌 前列腺特应性抗原 诊断 

分 类 号：R737.25[医药卫生—肿瘤] R730.43[医药卫生—临床医学]